What is the recommended screening for prostate issues in the US?

From the Guidelines

The recommended screening for prostate issues in the US includes a prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) for men at average risk beginning at age 50, with earlier screening recommended for high-risk individuals, including African American men and those with a family history of prostate cancer, starting at age 45 or 40 for men with multiple affected relatives. The decision to screen should be based on an informed discussion between the patient and their healthcare provider, taking into account the potential benefits and harms of screening, as well as the patient's individual risk factors and preferences 1. The PSA test measures a protein produced by the prostate, with levels above 4.0 ng/mL generally warranting further investigation, while the DRE allows a healthcare provider to examine the prostate gland for abnormalities in size, shape, and texture 1. Screening intervals should be determined based on initial PSA levels and risk factors, with annual or biennial screenings recommended for men with higher PSA levels or increased risk 1. It is essential to weigh the potential benefits of screening, including the detection of clinically significant prostate cancer at an early stage, against the potential harms, such as overdiagnosis and overtreatment of slow-growing cancers, as well as the risks associated with biopsy and treatment 1. Ultimately, the goal of screening is to detect prostate cancer at a stage when it is most treatable, while minimizing unnecessary procedures and avoiding harm to patients.

Some key points to consider when making a decision about prostate cancer screening include:

• The potential benefits and harms of screening, including the risk of overdiagnosis and overtreatment
• The patient's individual risk factors, such as family history and age
• The patient's preferences and values, including their willingness to undergo screening and potential treatment
• The potential consequences of not screening, including the risk of missing a diagnosis of prostate cancer
• The importance of informed decision-making and shared decision-making between the patient and their healthcare provider 1.

In terms of specific guidelines, the American Cancer Society recommends that men at average risk should receive information about the potential benefits and harms of screening starting at age 50, while men at higher risk should receive this information starting at age 45 or 40 for those with multiple affected relatives 1. The US Preventive Services Task Force recommends that men aged 55-69 years should discuss the potential benefits and harms of screening with their healthcare provider, while men aged 70 years or older should not be screened 1. The American College of Physicians recommends that clinicians should inform men between the ages of 50 and 69 years about the limited potential benefits and substantial harms of screening, and that screening should not be performed in average-risk men under the age of 50, men over the age of 69, or men with a life expectancy of less than 10-15 years 1.

Overall, the decision to screen for prostate cancer should be individualized and based on a thorough discussion of the potential benefits and harms, as well as the patient's individual risk factors and preferences.

From the Research

Recommended Screening for Prostate Issues in the US

The recommended screening for prostate issues in the US is a topic of ongoing debate and research. Several studies have investigated the benefits and harms of prostate-specific antigen (PSA) screening, which is currently the most commonly used method for detecting prostate cancer.

• The US Preventive Services Task Force (USPSTF) recommends that men aged 55 to 69 years discuss the potential benefits and harms of PSA screening with their clinician and make an individual decision about whether to undergo screening 2.
• For men aged 70 years and older, the USPSTF recommends against PSA-based screening for prostate cancer, as the potential benefits do not outweigh the expected harms 2.
• A study published in the Archives of Internal Medicine found that the benefits and harms of PSA screening vary substantially with age and familial risk, and that men should be informed of the likely benefits and harms of screening 3.
• Another study published in the Journal of Urology found that men with low baseline PSA levels (less than 2 ng/ml) may not need to be screened annually, and that screening every 5 years for men with baseline PSA levels less than 1 ng/ml and every 2 years for men with PSA levels between 1 and 2 ng/ml could result in a 50% reduction in PSA tests without missing earlier positive screens 4.
• A study published in the World Journal of Urology found that men with baseline PSA levels of 0.0-0.6 ng/mL may benefit from longer screening intervals than those recommended in current guidelines 5.
• A secondary analysis of a cohort in the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial found that baseline PSA levels among men aged 55 to 60 years were associated with long-term risk of clinically significant prostate cancer, and that repeated screening can be less frequent among men with low baseline PSA levels (less than 2.00 ng/mL) and possibly discontinued among those with baseline PSA levels of less than 1.00 ng/mL 6.

Key Findings

• PSA screening can help detect prostate cancer early, but it is not without risks and harms, including false-positive results, overdiagnosis, and overtreatment.
• The benefits and harms of PSA screening vary depending on age, familial risk, and baseline PSA level.
• Men should discuss the potential benefits and harms of PSA screening with their clinician and make an individual decision about whether to undergo screening.
• Screening intervals can be tailored to individual risk factors, with less frequent screening recommended for men with low baseline PSA levels.